Case 26: 55-year-old female with undifferentiated connective tissue disease presenting with Acute Kidney Injury
To preserve patient privacy and for didactic purposes, case descriptions and pathology reports have been anonymized and partially fictionalized. The pathology images are representative images from a mixture of similar cases.
John DanzigerCase Presenter | Beth Israel Deaconess Medical Center, Boston, MA, USA | No conflict of interest reported
Isaac StillmanNephropathology Discussant | Beth Israel Deaconess Medical Center, Boston, MA, USA | No conflict of interest reported
Eduardo HaddadNephrology Discussant | Lawrence General Hospital,Boston, MA, USA | No conflict of interest reported
Patient is a 55-year-old female with thrombocytopenia and a positive ANA, who was diagnosed to have undifferentiated connective tissue disease (+anti Ro Ab, prolonged PTT) without any systemic manifestations of systemic lupus.
Her serum creatinine had been around 1.1 to 1.4 mg/dl and urinary protein around 0.1 to 0.3 g/g. More recently, a sudden rise in creatinine to 1.8 mg/dl and a newly positive dsDNA prompted referral for a renal evaluation.
Medical history: She has had a thrombocytopenia and prolonged PTT for many years. As part of the workup, she was found to have a lupus anticoagulant. No history of thrombosis. Moderate-severe mitral regurgitation Hypertension Obesity Obstructive sleep apnea Hypothyroidism: Status post thyroidectomy for goiter Urticaria Anemia